HIV self-testing: what GetaKit can tell us about Canada’s $8 million one-time investment

Abstract

At the 16th International AIDS Conference in Montreal, Canada’s Federal Health Minister announced that the Government of Canada will invest $17 million to increase access to HIV testing, $8 million of which would be used to purchase and distribute HIV self-tests. While HIV testing, and subsequent diagnoses, is a critical first step to achieving the updated UNAIDS goals of 95-95-95, testing on its own does not guarantee linkage to treatment or prevention services. In other words, it does not alone guarantee progress toward the 95-95-95 goals. GetaKit, Canada’s first HIV self-test mail-out project, has demonstrated that a preliminary risk-assessment consistent with US CDC and PHAC screening guidelines ensures targeted uptake among communities most affected by HIV, thus minimizing the risk of false positive results and poor positive predictive values. Furthermore, HIV self-testing must link not only individuals with positive results to treatment, but also persons with negative results to pre-exposure prophylaxis (PrEP) along with re-testing as required. However, both access to treatment and PrEP remain inconsistently available across Canada. Therefore, while this one-time investment of funding to increase HIV testing is encouraging, without clear instructions as to who should be prioritized for testing and definitive next steps to ensure that individuals are successfully linked to care, Canada risks wasting resources, further exacerbating pre-existing inequities.

Targeted HIV Self-Testing Identifies Persons with Undiagnosed HIV and Active Engagement Links them to Care: The GetaKit Study

“…HIV testing is one means to reduce the proportion of persons with undiagnosed HIV infection – and to fulfill the 2030 UNAIDS 95-95-95 targets [ 8 ], wherein 95% of persons living with HIV are diagnosed, 95% of those diagnosed are linked to care, and 95% of those linked to care achieve undetectable viral levels. HIV self-testing, as the newest technology, has been heralded as one strategy to help achieve these UNAIDS targets, and this is because observational research shows that it often (1) corresponds with high uptake among HIV priority populations and (2) demonstrates test positivity comparable to or exceeding that of testing done in traditional settings [ 9 , 10 ].…”